The rural U.S. population ranges from 20 to 49 percent depending on the definition used. These Americans suffer disproportionately from chronic illnesses such as cancer and are known to be at risk for poor health outcomes like mortality as well as morbidity concerns such as health-related quality of life (HRQOL). This risk is aggravated by a diagnosis and treatment of cancer with potential distressing long-term and/or late effects. With cancer survivors numbering more than 11 million consideration of HRQOL, a key outcome of disease and treatment as well as a predictor of mortality and cost of care, is a priority for the rural population of cancer survivors. Within this population the proportion of long-term (L-T) (5 years beyond diagnosis) has grown to 66%. Furthermore breast cancer survivors (BCS) make up 41% of all cancer survivors yet this group remains poorly understood in the rural setting. Long-term cancer survivors, as opposed to acute survival typically focused on cancer biology, and treatment, who are rural residents face additional challenges to survivorship that stem from cancer disparities associated with lower socioeconomic status, higher age-adjusted death rate, and reports of poorer health status. Rural cancer survivor research to date dose not capture the complexity of HRQOL for rural L-T cancer survivors. To minimize the two-fold risk to HRQOL stemming from being a rural resident and a L-T survivor a clear understanding about complexities of L-T cancer survivorship in the context of rurality is necessary. Given this backdrop the purpose of the study is to describe rural HRQOL for L-T BCS. Study Aims will identify macro/systemic level (social-ecological, cultural, healthcare, demographic) and micro/individual level (psychological well-being, cancer-specific medical factors, general health and comorbidity, health efficacy) contextual dimensions of HRQOL for rural long-term women breast cancer survivors in Colorado. This project is likely to exert a far reaching and important influence on future interventions to improve the HRQOL of L-T breast and other cancer survivors from rural areas because of the HRQOL information to be gained directly from rural L-T BCS and their support and service. This unique approach (descriptions from BCS and key informants) will extend the characterization of L-T survivors in the sub-population of rural BCS residing in three Colorado rural categories of the 2003 Rural-Urban Continuum code. The results of this study will have applicability to HRQOL interventions that are culturally (rural as primary culture with ethnic/racial and age considerations) appropriate for this growing sub-group of cancer survivors at the micro and potentially macro level. PUBLIC HEALTH RELEVANCE: The proposed research study is relevant to the health of the public because it is likely to exert a far reaching and important influence on future interventions to improve health related quality of life (HRQOL) of long-term breast and other cancer survivors from rural area. The data collected directly from rural long-term breast cancer survivors and their support and service providers familiar with the underserved rural population will contribute to understanding the complexity of rural HRQOL. The identification of macro/systemic and micro/individual contextual dimensions of HRQOL have applicability to HRQOL interventions that are culturally (rural as primary culture with ethnic/racial and age considerations) appropriate for this growing sub-group of cancer survivors at the micro and potentially macro level.